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Calalang-Javier, MSN, RNC, IBCLC
Often times, time management is a challenge to new staff or even staff that has been in the workforce a long time. A new electronic patient record documentation system (EPRDS) was implemented in the hospital where I used to work and most staff attended the in-service. The EPRDS is familiar to the nursing staff in this hospital, but most people needed a refresher course on this new version of documentation. The previous program was initiated five years ago.
The new program is an upgrade of the current electronic patient record documentation system. A new feature of this program is the direct physician order entry. The physician will now enter the order in the new documentation system that goes directly to various disciplines or departments where it is reviewed and processed. For example, the patient’s diet order will go to the dietary department where it is reviewed, processed and the diet is delivered to the designated unit. When the physician orders medication, the pharmacist will review it, and sends the medication to the designated unit. This direct order from the doctor to the pharmacy will ensure that the correct medication and dosage is delivered for the nurse to give to the patient. Because the pharmacist is the one who interprets the doctor’s order and it is the pharmacist who verifies the order. With this new process of medication transcription, a medication error is most likely minimized or eliminated. The EPRDS facilitates review of the patient records, advocacy of the patient’s needs, and collaboration of nursing care with other disciplines because duplication is reduced thus time is well spent. In addition, because it is a digital record, time is saved by not having to search through paper records. In addition it is cost effective to the organization.
However, there is a new challenge that arises among the staff in the use of
Safeguard password and logout if moving away from the computer to see patient. “If it is not documented it is most likely not done. Learning the new icons and the new format can be tedious and time consuming. the famous writer said. Ask for assistance from the superuser staff. According to Stephen Covey. As Napoleon Hill. and attending mandatory classes can take up the nurse’s time and delay completion of nursing tasks. “Do not wait. A good knowledge and application of time management skills is very important. All these must be taken into consideration when organizing and prioritizing activities. and especially nursing documentation are the important aspects of a nurse’s daily routine and must be done with accuracy.” Additional activities such as attending committee meetings. the time will never be ''just right. who wrote the book on “The 7 Habits of Highly Effective People. Review entry notes for accuracy. Spending time just completing the documentation on the computer leads to less time spent at the bedside. Just remember that time is precious.'' Start where you stand. patient education. Tips for digital documentation Keep the electronic documentation quick reference guide handy. making nursing referrals. Direct patient care. Set up the digital personal patient list.” time management is the ability to “organize and execute around priorities. nursing tasks must be prioritized in order to provide safe patient care. Set the goals for the day.the new electronic documentation system.” When providing patient care at bedside. . Combining computer proficiency and fulfilling direct patient care can be challenging each day. As the saying goes in nursing. Place your patient information timely.
” A Caring Nurse . and better tools will be found as you go along.and work with whatever tools you may have at your command.
MSN. we hear the common expression. Jean Watson is famous for her philosophy and science of caring and in her book published in 2005 called Caring Science as Sacred Science. Nursing is a noble profession and nurses have contributed their commitment and dedication to their patients. support and love. According to Dr.Guest Author - Helen V. and scientific framework.” The nurse’s job of caring for patients is a physical manifestation of a caring attitude and calling. Dr. What then is it in the care given by a nurse that is so powerful that it can actually lead to the process of healing? Dr. IBCLC Nothing is more worth recognizing than nurses’ accomplishments big or small every day and thanking them for keeping the profession of caring to move on. a harmony between science and the humanities acknowledges a deeper value of quality of living and dying that involves ethical. she discusses the concept of caring and healing for health professionals based on moral. Watson identified ten carative factors as the core processes involved in the professional practice of caring. “I care about you. RNC. philosophical. giving comfort. Calalang-Javier. moral and psychological components. Watson.” or “I will help you overcome this. physical. Why is caring unique when given by the nurse versus given by just anyone? Often times. These core factors are: • • Faith and hope Humanistic system of values .
Once the inner healing field is touched. emotionally. This conscious caring attitude and skill is enhanced through practice over time. As a professional nurse. Fulfillment of human needs Promotion of transpersonal caring and love The caring energy is powerful that enhances healing with the core factors involved in the process. physically. tapping on the inner healing field of the patient. The nurse emits a much higher frequency of caring energy than the energy of a sick patient that converge into conscious healing process thus.• • • • • • • • Sensitivity towards others Trust Expression of positivity and negativity Problem solving Promotion of learning relationships Provision of support. the healing process begins. Showing how one appreciate and value the contributions of nurses to the caring nursing profession will surely provide encouragement to keep the caring energy flowing! . spiritually. one is equipped with nursing knowledge with the integration of the clinical carative factors. critical thinking skills.e. The basic idea is that all around us is made up of energy and everyone emits some energy. The caring energy that resonates from the nurse to patient restoring ones normal health is incomprehensible. i. etc. and the consciousness of caring that promotes the caring-healing relationships with the patient.
The inexperienced nurse is warned of it constantly. but the financial health of our institutions. (4) These four statistics are enough to ensure that no matter where you work. One of the first things to do is ask them on admission if they have had any falls in the last year. then your institution is out of compliance and will be implementing these strategies soon. and document your preventive actions each shift.Fall Risk and Prevention As many nurses are aware. you have had the pleasure of taking a mandatory course on fall prevention. Just to be clear. take quizzes. . If they have. (2) “Ten percent of fatal falls for older adults occur in hospitals. “Falls account for 70% of accidental deaths in persons 75 years of age and older. The experienced nurse has seen this firsthand. let us look at some statistics. They effect not just the health and lives of our patients.” (1) A 2004 study conducted by JHU found that short term risk of single and recurring falls was three times higher for the two days following a medication change. You have had to fill out paperwork.” (3) Goal 9 of The National Patient Safety Goals from JCAHO is to “reduce the risk of patient harm and to implement a fall reduction program“. then they are automatically a high fall risk. falls are a big problem. If you have not been doing this.
Imagine you are an older woman who has been placed on a new medication that increases urinary frequency. Every patient should be required to notify staff when they are . They may need to stand to urinate. and urinary urgency or incontinence. If the patient is on a benzodiazepine. Assess the patient for neuropathies and residual weaknesses from strokes as these can also be contributing factors to loss of balance and weakened gait. (5) Any blood pressure. then they are at high risk for falls. or pain medications increases their fall risk. then a referral to physical therapy is appropriate to help them maintain a level of ADL capacity for safe discharge home. then you need to focus on education to keep them at a low risk level. The risk to each patient can vary from hour to hour. This is a new problem and you are embarrassed by how often you need to use the call bell. every shift you work. a patient’s level of consciousness has changed. This can be in the form of handouts or verbal reminders.(5) Some other more obvious things to assess are visual impairments. This should easily allow the staff following you to see what you have assessed and follow the appropriate interventions. One of the less obvious questions would be concerning medication use. you will be doing a fall risk assessment. It is likely that you may attempt to go the bathroom independently. Discuss with your new admission the type and frequency of physical activity normal for them. your organization will probably have some type of chart for rating their risk. They may misjudge their own capacity and balance. After you have assessed your patient on admission. and is something that you must become aware of in your daily practice. If your patient is a low risk. If a medication has changed. but be weak from their condition. all of these can change the risk. Another scenario would be the COPD patient. use of cane or walker. For every patient. they are experiencing pain or shortness of breath. glucose. seizure. If they are going to be more immobile during their admission than they are at home.
flags on the chart and doorways. You have been whipping around the halls. Keep commonly used patient belongings within reach. Many of us forget that once a patient’s pain is relieved. Explain to them how dangerous and common falls are so that they truly understand the risk. while we may be expecting them to be lying still. Use of personal alarms may be something available to you for the frequently confused patient. Be sure to involve visitors to the patient in this vigilance. This will allow you to assess their ability and give them a motor memory reminder when needed. Be sure to communicate your expectations and listen to their perceptions of the plan of care. hourly rounding. Some of the more popular interventions include no-slip socks. and any equipment in the room that is on wheels such as tables or poles. then this can be taken on a shift by shift basis. or cardiac response. be sure to warn them. getting up slowly from supine to upright positions. Other things to remind low risk patients about include wearing no-skid slippers or shoes. and planning three steps ahead. It can be helpful to have the patient demonstrate proper call bell use during your initial rounding. These systems can be invaluable in protecting your patient and saving them from injury. . If your patient is high fall risk. If there has been administration of a medication that could change their balance. Be sure to only use the top two rails of the bed! Anything else is considered a restraint by law and will necessitate following your restraint protocols. They are not moving at your pace.going to be ambulating in their rooms. This will engage them in doing something helpful to the patient and make them feel included in the care plan. multitasking. and bed alarms. This is especially important with pain medications. then you need to do as your institution mandates. When you do get your patients up be sure to use care and caution. cognitive functioning. Do not hurry them. as well as the call bell. they may assume that they can resume normal activities. If a patient has demonstrated safety. ever.
jointcommission. and you will have significantly reduced your patient’s risk of fall. Be sure to address this by establishing trust. another common sense assessment at rounding each shift. you want to be sure that this won’t offend them. This is often a sign of pain or fear. injury. but most of them laugh and then stretch their backs into the proper position for correct balance. Focus on the task at hand.PDF (5)Tromp AM et al.cdc. This causes them to reverse the shuffling hunch that many patients pose. The bottom line is a good assessment at admission.They have been lying bored in bed or waiting patiently for someone to come and help them. and talking to them about their experience. Fall-risk screening test: a prospective study on predictors . (1) Am Fam Physician. and death. (2)http://www. 61(7): 2159-68. doesn’t it? It isn’t.html (3)http://www. making eye contact. 2173-4. keeping a firm steady hand on them. it sounds time-consuming. and monitoring the safety measures in place.ihi.org/IHI/Topics/PatientSafety/ReducingHarmfromFalls/ (4)http://www. really. Combine those with a positive attitude and careful assistance when ambulating your patient. Having said all that. Remind them to tuck their tailbones under and lift their chins. I often joke with my patients when they first stand up to “show me their boobies!” Obviously.org/NR/rdonlyres/D619D05C-A682-47CB874A-8DE16D21CE24/0/HAP_NPSG_Outline. 2000 Apr 1. Many of them will even comment that it feels so good to stand up like that! Notice if your patient is shuffling their feet.gov/HomeandRecreationalSafety/falls/FallsPreventionActivi ty.
Instead. but so are the bacteria and viruses with which we battle. I ended up washing my hands with soap and water about every third visit to a room. but made me feel much cleaner. This also requires soap and water. Hand Sanitizing Foam Nurses are busier than ever. and is not killed by the foam. but the focus is on patient contact. The foam. How many of us have at least one isolated patient on our modules when we work? The hand sanitizing foam is ubiquitous at all institutions. They are more resistant and getting more so everyday. My hands got slimy. 54:837-844. Do you touch the beeping IV button? Do you touch the button to silence the call bell? Do you set your papers down on the table? Do you use your pen after . 2001. The foam is also to be used at other times.for falls in community dwelling elderly. as most know. unless your hands are “soiled”. Journal of clinical epidemiology. is to be used anytime you leave a patient room. The other exception is for cases of c. This added some time to my routine. I found out something interesting. It feels odd to use it as often as we should. but are we using it properly? Do we put our patients at risk by going from room to room without foaming or washing every time? I spent my last shift paying particular attention to how often I used hand foam. Think about how you use your hands when you enter a patient’s room. difficile infection. in which case you should use soap and water. It was not realistic to use it the way the administration intends. as it is a spore.
and endangering your patients. rewarding those who are consistently in compliance by recognition and compensation ranging from prizes to tying it to pay increases. The best of these programs focus on the positive. People from all over the world recognize the significance of this historic occasion. depending on the finding. blinking green or red. The sensor notes the presence of ethyl alcohol. but how many really understand the amount of work that will be necessary to change the face of the “political . BSN.com/news172334382. increasing length of stay.physorg. Virginia Commonwealth University is starting a sensor program to track foam usage by health care workers. Some hospitals currently track the amount of foam used. but this data does not give information about when the foam is being used. RN The excitement is in the air as President Elect Barack Obama prepares to take office on January 20th. before you wash? Do you clean your stethoscope between patients? Do you only use the foam after you take off gloves and not when you have done something you don‘t think of as “unclean“? All of these are pitfalls into spreading disease. only how much of it. and shows the importance of getting into the habit of fitting this step into your routine now.Get Involved Guest Author Bethany Derricott. Reference: (1) http://www. (1) This opens up an arena of tracking not before used.you have touched the patient. Another way hospitals survey their staff is to assign staff members to observe.html Political Activities for Nurses . and report about their co-workers. record.
This is a yearly workshop sponsored by the Nursing Organizations Alliance which teaches nurses about the legislative process and how to influence health care policy. Start by visiting the online Thomas Library of . Apply to be a Fellow in the White House Fellowship program. You can also get involved with specialty nursing organizations that participate in political activities. what can nurses do to affect real change within the political world? The answer is a lot! Below is a list of political activities in which nurses can participate in to change not only the way nursing is practiced. 2. Become a member of the American Nurses Association. Research health care and nursing issues that are currently being considered by Congress. but also the way health care is practiced…So. 3. So. such as the Association of Women’s Health. nurses can play a unique role in creating change within the health care system and nursing practice. These organizations develop policies and work to make changes within the health care system. get involved: 1. as well as nursing practice. Fortunately.scene” in the US. that legislates and supports nurses and nursing practice. to name a few. but we also understand the day-to-day issues that affect patients and their families. This paid position allows participants to work directly with White House Staff and high ranking government officials to affect change in legislative policy. the American Association of Critical Care Nurses or the Academy of Medical Surgical Nurses. We not only understand various facets of the health care system. Obstetric and Neonatal Nurses.S. The ANA is the largest professional organization in the U. 4. especially in regards to health care? I would venture to guess not many. Attend the Nurse in Washington Internship (NIWI).
Write an article for a nursing journal or magazine. For example. This is a great way to let the public know about important issues. 5. Call local or national radio talk shows. 10. you can contact political leaders in your area to learn about current issues and ways to get involved in activities that will support important health care and nursing legislation. you can contact the Patient Advocacy Foundation to locate resources that will support patients and their families. you could contact The AIDS Institute to assist in activities that will further important legislation. This will help to support legislation that is important to your practice. Lobby the manager or administrator of your own health care . If you are interested in more local issues. 11. state and/or federal leaders. 6. 9. or if you are more interested in patient advocacy. Research the internet for organizations that support issues in which you are interested. if you are interested in issues related to HIV/AIDs. Use this forum to “spread the word” about issues important to nurses and patients. This will help to alert other nurses about important political issues. 7.Congress. Start a letter writing campaign or petition in your hospital or health care organization. Write a letter to the Editor of a local or national newspaper. Contact local political leaders. 8. Letters and petitions can be sent to local. Contact the State Representative or Senator supporting the bill you are interested in to find out ways to get involved.
then. 12. Not all political activities require a visit to Capitol Hill. Taking the time to document the efforts you have made at including your patient and their families in the plan of care will also help you focus your nursing care toward the subjects that have the most impact on outcomes and lifestyle changes. It is what separates you from the non-professional and holds you responsible. “If it isn’t documented. So. get involved! Why Should I Document Education? How many of us have heard the adage. Educate others. 13. Ask them to pass the information on to others.agency about issues that directly affect patient care and nursing practice in your facility. Documentation is your accountability. Sometimes starting right in your “own backyard” is the best way to initiate change. For those of you who do not have the time to participate in “lengthy” legislative activities. Research issues or policies that are important to your practice. simply find a legislative bill or advocacy organization that interests you and send an email about your findings to coworkers. it isn’t done?” All of us. friends and family. Provide a short in-service to coworkers to educate them about the issues you explored. Nurses know that educating others is a great way to affect change. why do so many of us leave out documentation of education? It is a standard of practice expected by the Joint Commission and the ANA. . many only require the willingness and creativity for which nurses are known. One hallmark of professionalism is accountability. right? So.
every shift. but only a professional can . written. who was learning. medications. Anyone can push pills and change dressings. An example would be a box where you choose from a drop-down menu of topics covered such as safety. establishing a sense of trust and knowledge between you and your patient. When you offer a cup of fresh water to your patient. but not giving ourselves credit for it. then your facility probably has a computerized flowchart for education documentation. do you document that as education? These are all examples of how we are already doing the work. This is what we went to school to learn to do. You assessed the need for education. the willingness of the learner. and how they received the knowledge you imparted. or demonstration. If you have documentation by exclusion. Then the next box would include the way you taught. Documentation of who was taught the information should also be included. do you know what you are giving? Have you thought about why that particular patient is receiving those particular medications at that particular time by that particular route at that particular dosage? Since you have. Did they ask questions. We are shortchanging our own profession when we think that it is less than important to document education. or treatments. do you remind them that you are documenting how much they eat and drink? When your patient hurts and you ask them the score on your institution’s pain scale. such as verbal.When you give a cup of medications. or were there barriers to learning such as denial or severity of illness? All of these pieces follow the flow of your care. The last component is how the education was received. This is the information required by your professional licensure and should be documented for each patient. then why not talk about one of them when you administer it? Your dialogue would reflect your professional role. verbalize understanding.
You have the opportunity to empower your patients and improve their outcomes and quality of life. .educate and change lives.
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